Five phases of grief

Elizabeth Kübler-Ross was a doctor in Switzerland who studied the effects of grief on people who learned they had a terminal illness. Her studies showed a trend for people to experience five distinct phases of emotion and reactions. Not all people experience all five phases, nor do people necessarily take them in order.

I will cover these stages and some of their meanings and implications soon. First I would like to discuss what this model can help with and what it isn’t designed to assist.

The Kübler-Ross model is probably the most famous model of grief. It is well used in television and pop psychology as a script that people will go through (youtube example from The Simpsons). To take it out of the pop psychology script and bring it back to real life, consider the following.
Being a model, it describes common experience. Outliers and other oddities are taken out of the data such that an “average” can be created. This means that this model may, or may not, apply to you or the situation you are aiding in. This doesn’t mean that someone who doesn’t follow this model is wrong, weird or faulty. It just means this model doesn’t apply.

The model was based on observing people who knew they were going to die. It can be extended to any up coming expectation of loss, such as a job, a partnership, house, country and so on. While this model may be applicable to sudden and unexpected loss, it often does not apply to it, nor was it based on observing people who experienced sudden and unexpected loss. In practical terms, that means if you know you are going to lose something (life, job, partner etc), this model is likely to be useful, whereas if you find yourself unexpected affected by the loss of something (life, job, partner), this model is probably not useful to you.

I see a large proportion of people who are going through the end stages of their relationship go through phases of this model while they are coming to terms with the cessation of their partnership. Often their partners, who had very little idea it had come to this, go through another grief process as their relationship unexpectedly ends.

On with the phases/stages/levels or whatever you choose to call it.

Anger
Anger is a response to your perception of personal power being decreased. Often this is due to someone or something crossing a boundary, but in this case, it is the knowledge of the upcoming loss. You are going to lose something and you are not only unhappy about it, you are angry.

People who experience this stage will often be very down on themselves, lash out seemingly irrationally at those around them, push people away and may act quite aggressively. A great deal of this aggression is transferred anger at the situation being passed to others and self. It is an attempt to compensate for the perceived loss of power.

Anger can drive efforts to change the situation and avoid the loss. It is a great fuel if balanced, but it often clouds the issue and you can miss opportunities that can change the situation. That is the risk if the anger goes too far.

Summary: Anger is an emotional response to the impact of loss and how that changes the self. Aggression can be transferred away from the loss to bystanders. Anger can be channeled towards positive outcomes. Anger is not wrong or bad.

Denial
Some say that Denial is a river in Egypt, but it is more than that. It is an attempt to hide from the severity of the loss, a dulling down of the pain associated and the impact it is going to have on ones life. Denial is a safety mechanism to avoid being overwhelmed by loss.

It can be easy to mis-diagnose someone as being in denial because they do not appear to be doing anything about the upcoming loss. We may feel that something should be done about the situation and we see no action, the individual doesn’t want to discuss the expected loss, and seems to be determined to get on with their life. What we may not see is the internal battle to understand the enormity of the loss and internal processing of how that loss is going to affect the world, both subjectively and objectively. For example, if you learn you are going to die, who will feed the dog, look after the children and will you go to a better place? Some people prefer to do a great deal of this processing internally rather than talking about it. You don’t have to talk.

In balanced doses, denial is useful for continuing the life process while the mundanity of life continues. At some stage, someone has to cook dinner, wash the clothes and so on. Becoming lost in the process of life can be a respite from grappling with the expectation of loss and how that is going to affect the world.

Out of balance, denying the probability of loss can deny the person of pre-processing the loss and preparing for change. Being lost in denial can interfere with setting up changes in life for the upcoming loss and leave the person in a different form of grief, that which occurs with sudden and unexpected loss. More on that in another post.

Denial can also concatenate with Bargaining to create a search for the miracle solution. I’ll discuss that in more depth in the Bargaining phase.

Summary: Denial in balanced doses allows for the continuation of life before the loss, can be a safety valve when things are too intense and can allow a person to internally process the implications of change. In excess denial can delay change and leave someone dealing with unexpected loss instead. Denial is not a bad thing, or wrong.

Bargaining
In general, bargaining is trying to get what you want for the cheapest price. The harder, more complex, or impossible something is, the more we will offer.

In expected grief, the bargain has a central theme of trying to stop the loss or offset the negative aspects of the loss. It can take the form of offering to do something, pay something or sacrifice something.

In balanced amounts, bargaining can help you to find ways to minimise and offset the negative aspects of the loss and how it will affect you.

When balance is lost with bargaining, one can attempt to find a miracle solution to an impossible problem and offer incredible amounts to effect it. If this combines with denial, one can end up joining cult groups, losing all your assets to a con artist or embarking on an endless search for a way out of the change required by loss. This can be quite damaging to the self and may domino effect harm to others who care about you.

Summary: Bargaining is a natural part of searching for solutions. It is just an extension of problem solving. In moderation it can help find solutions to loss or minimise difficulties created by change. When out of balance, bargaining can lead to significant drama that can distract from the upcoming loss. If bargaining is combined with denial, this drama can become damaging to the self and others.

Depression
The emotions involved with expected loss and change can sometimes feel overwhelming. 

Neuroplasticity document

The Vermont Recovery page has some interesting articles. This one on Neuroplasticity is quite good. It is a downloadable PDF document.


“Neuroplasticity basically refers to the brain’s natural ability across the lifespan to form
new connections and change its structure in response to experience.  This means the brain can
change itself physically and functionally at any age to compensate for injury and disease and to
adapt to new situations or changes in the environment.”


“Traditionally, the adult brain was considered relatively hard-wired and fixed, a prognosis
that  lowered expectations about the possibility of  curing the alleged brain problems that
underlie psychiatric disorders.  Thus, in the medical world, schizophrenia and bipolar disorder
have been conceptualized as life-long, incurable brain pathologies that a person can learn to
manage, but never completely  resolve.    However, these hypotheses  have always been
problematic, for longitudinal  studies have  demonstrated again and again that  a significant
amount of people diagnosed with schizophrenia completely emerge from psychiatric symptoms
and no longer use medications.
4
  These individuals pose this challenge to neurobiology:  if their
previous symptoms were in fact due to a broken brain, are their brains now fixed?”

To solve a complex maze, start at the end… Life is a complex maze

A simple maze can be solved from the beginning. You move through a few simple turns and find yourself at the exit. If the maze is more complex, it makes more sense to start at the end and track your way back to the beginning. Life is much the same.


When a problem is easy to solve, we can easily move forwards without having to have a clear idea of what the exit looks like. We make a few moves, a couple of turns in the maze of life, and we easily find the exit to our problem.We have solved it.

When life is more complex, sometimes we don’t really know where we are heading, what our exit looks like, what it is we hope to achieve. At this point, we don’t know anymore which turns are good, which decisions are beneficial and what to do. So, stop trying to make your way from the beginning and cheat. Look at the end you want and work backwards.

Math proofs do this too. You progress the left hand side of the equation to look more like the right, you progress the right to look more like the left. If you manage to get them meeting in the middle, you win.

Some mazes are so complex, much like life, that you need to set goal points in between the start and end. These are great steps to help you get to the end.

If you do not look at what where you want your life to go, then you may find that you are running away instead of heading towards. This can sometimes look similar. The difference is that running away means all of your present decisions are made in fear, while heading towards means your present decisions are made in hope. This can significantly shape the feel and end result of your life. Thus I recommend you consider your destination.

Loss leads to grief

Loss leads to grief, grief leads to the … sorry, wrong blog.


This is by no means a compete guide to loss and grief.


Ok, loss is something that everyone experiences. Whenever something that we feel a connection to is gone, we experience a loss. Loss can be as simple as misplacing your car keys, to being consuming like the death of a loved one, ambiguous like the loss of a bet where you were counting on that win, or complicated like the death of a sick relative.


The common link is that something has gone that you had an emotional tie to. Without that emotional tie, you do not feel loss. This emotional tie can be quite complex. It can be a sense of belonging, love, hope and so on. The breaking of this tie can create follow on emotions, such as anger, shame/guilt or grief.


Anger is the emotion we often feel when we feel powerless or hopeless. It regains our sense of power and ability to create change around us. When we don’t know how we feel, and we feel lost, we humans feel anger and we can become aggressive towards ourselves and others. That aggression often has damaging aspects of social, psychological or physical aspect. Aggression is not the only solution to anger. There are other ways of expressing your feelings of anger and better ways to regain your power.


Guilt is the emotion we feel when we think we should have acted differently and we feel responsible for the outcome. Often this subjective feeling of responsibility is inflated compared to objective reality. It is that skerric of possible truth that lays us down. We exaggerate any possible truth in our action that can mean we are responsible for the loss we have experienced. To minimise this, take a fresh look at the loss and the actions you feel lead to the loss. Did your actions alone lead to this loss? Or were others involved? Are you sharing the responsibility, or are you taking a god like credit?


Shame is the emotion we feel when we think that others consider we have done the wrong thing. In this instance, we can feel shame if we think others are judging us responsible for the loss we are experiencing. So long as we place an exaggerated emphasis on other people’s possible or actual opinions of us, we are going to feel trapped by shame. To combat this, realise that people are entitled to their opinion, whether true or false. It doesn’t matter what people think about you in this instance – this is a time for you to be more concerned with how you are feeling, not with how other people are feeling.


Guilt and shame can blind us to feeling the emotions we need to feel to deal with the loss. This emotion is grief. Grief comes in several flavours. The most well known is the Kübler-Ross model, commonly known as the “five stages of grief”, also there is the flavour of simple grief and the bitterest flavour is complex grief.


I will spend a blog post on each of these.

Shopping for Therapists

There are many good therapists out there in the wide world, the tricky thing is how to identify them.


First, let’s get you into the right mind frame. If you take your car to a mechanic and you don’t like the way they treat you or your car, you don’t go back to that mechanic, you find a new one. If you don’t like the way the shop feels, the language of the mechanic, the attitude, you don’t even leave your car there, you leave. Finding a therapist is a similar process. If you don’t like what they do to your mind and body, find a new one. If you don’t like the feel of their shop, find a new one.


There are circumstances where you have little choice, such as locked ward, community treatment order and other government sanctioned loss of freedom. Even still, you can go through the following questions to help you determine if the person you are working with is receptive to your benefit.


These questions have mostly been developed by Thomas Proud, a Peer worker.


1) What are your qualifications for helping me?


2) What experience have you got for helping me?


3) How many of your patients/clients have recovered their lives back?


4) Do you believe I can thrive?


5) What methods are you likely to employ in supporting my recovery?


6) Are you happy? If not, what are you doing about it? If nothing, what makes you qualified to help me?


If you like the sound of the answers you get, then this therapist may be able to help you. If you don’t, it is time to move on. If you can’t, perhaps you may have triggered the therapist to think about what they can and will do more so than usual.


If everyone begins to ask their therapists these questions, perhaps therapy will return to the old ways – that of a midwife of health.

Who am I?

As I write this, I find myself currently unemployed. This prompts a lot of questions about self, which launches many questions about the past, present and future.


While I was employed, there were many things I put up with because, well, that’s a job, right? I grew and changed, and that growing and changing did not reflect where the organisation I was with went. I attempted to confine myself within the bounds of my job, but that can only last so long.


Don’t mis-read me here – I didn’t leave the job because they aren’t doing cool stuff, nor simply because I changed. There were many factors. What I am referring to here is what can also be found in relationships, which, in effect, is what a job is. We grew, we changed, and it is rare for that growth and change to be in the same direction. This means compromise with change and goals. It is rare for a work place to compromise and change if you aren’t in charge, which means all the compromise needs to be with you. I am reviewing my compromises and wondering what that tells me about myself.


So my questions about the past become questions about my compromises and my growth. Thanks to where I was working, I have developed a more comprehensive understanding of recovery and thriving. I saw quite early that recovery was an early stepping stone to something else – wellbeing, completeness, EleMental… I wasn’t sure. I have developed my thoughts and have decided that Thriving Is It, although not as Mike Smith defines it. I’ll define it more later, in another post. This post is about me.


I compromised more than I feel comfortable with. The specifics of what I compromised aren’t specifically important here. What is important is that I did compromise, which is human, and it has affected me, because I try to be better than human. Compromise is a natural part of being human in a world of social interaction and difference of opinion. If none of us compromised, we would either all be exact clones, or we would kill each other on site. The world is full of people killing people due to a lack of compromise.


Yet somehow I want to hold myself better than that. I want to go beyond human, creating a dichotomy of “This is right” and “This is wrong” rather than accepting that my “This is” is allowed to be different to someone else’s “This is” and we can both be right. I appreciate that this is kind of vague and hard to grasp. Perhaps an example will help. “Thou shalt not steal” is an example I gave to my daughter. An easy principle to understand, if it isn’t yours, don’t take it. If you do, you are wrong. Yet if my daughter is starving and my only option to feed her is to steal food, then bugger the principle, I am going to steal some food. I hold the principle of “You will care for your child” higher than my moral principle of “Thou shalt not steal”. In effect, I allow that my principles can be compromised by other principles. Therefore, I must look at the context of other peoples actions rather than just judging them wrong. Even when I have looked at their context, even when I feel I can justifiably judge them wrong, I must also accept that I may not understand and could be just as wrong to judge them as I think they are wrong. Still very muddled, sorry.


In short, I want to be uncompromisable, but have to accept that I am human, I live in society with other humans, and therefore I can’t be better. That shouldn’t stop me from aiming to be better, but I shouldn’t kick myself for not being better.


This leads to my future. Where do I want to go? Clearly compromise is a big issue and I want to work somewhere that is more closely aligned to where I have grown and evolved in my present self. I fear that this place does not exist. This is one of the reasons I stayed as long as I did where I was – my fear of not finding it this good. Better the devil you know, isn’t it? Not always.


Some of my wilder futures can be ruled out at this present moment. I will stay in the state that I am in because that is where my daughter is. I will not start my own practice because I do not feel I know enough to do so and I am not sure who I would want as partners, or even if I could find viable partners, to fill up my short comings. I am not going to drive off into the sunset. Mostly because the sunset here is straight into an ocean. By the same token, although for slightly different reasons, I am not going to drive off into the sunrise either as I fear following my fathers foot steps, running away from his life rather than working with what he has.


That still leaves me with a number of uncertainties though. Will I work for a non-government organisation, or a government organisation, or a private practice? Will I be working with children, adolescents or adults? Will I stay exclusive to mental health, or dabble in substance abuse or justice? Where will I look and what will I aim for?


Which leads to the present. To know what to do now, I need to have a fair idea of what I am aiming for. Without having some level of definition of this, I find myself frozen in action as I fear shutting down an option of what is to come. Knowing who I am and where I am heading is so very important.

Friends

I’ve never been to good with friends. Understanding them, that is. What makes a good friendship?


When I was in my first primary school, the person I thought was my best friend was the guy who let me hang around him and didn’t know how to tell me to leave him alone. Of course, this is my perception of my past and he may tell a different story. The guy I put up with turned out to be the guy I knew for the longest time – and also the person who helped save my sanity.


In my second primary school, I made a new best friend, who again wasn’t really a friend, but rather someone who again didn’t know what to do with my attentions. We got on fairly well for a year I think, but then it just proved that neither of us knew what to do with the other. We drifted apart.


High school wasn’t too much better. I was a loaner for the best part of my early years. I finally started to get the hang of friends in my tenth year of school when I change to a high school full of people who I had escaped from primary school. Not a good combination. I left that high school confused and hurt.


I knew it was time to leave when I couldn’t tell the difference between what I had dreamed and what had happened. Not a good thing.


I went back to the first high school and all the friends I had made in my tenth year were gone (that’s what happens when you repeat year 12). I started making better inroads to friendship in this year, but it wasn’t ones that lasted.


University was … more mature? Again, I didn’t keep any friends I made from this setting.


So, to me, I guess, friends are people who last beyond the setting you met them in. Otherwise they are companions of convenience you don’t mind hanging around. I’ll add more to this later I guess.